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FC%R OFFICE USE: APPLICATION FORy SANITATION PERMIT 3_ 3 . ... Permit No. _._.. . .... i (Complete in Triplicate) s Date Issued 4,_ .... .,.. - This Permit Expires 1 Year From bate Issued Application is hereby made to the San ,Joaquin Local Health District for a permit to construct and install the work herein described, This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: . ........................CENSUS TRACT •------- ..........:.. JOB ADDRESS/LOCATION ......_..�1..-L..-_..._. :--- .�� -..._..._ .. Owner's Name ----- //._r._.... l( ....... .................. , one Address . .. - ---- ... _ . .�+CJ.-s. .. ............. ..._. y " 1'l"r Phone Contractor's Name .. _/ice - j. --. .�f' '- - License # .. .._.. .. Installation will serve: Re si den ce'V Apartment House-[] Commercial ❑Trailer Court -[] Motel ❑Other .................... .......•---•-----...._ - Number of living-units:........ Number of bedrooms _-'.....Garbage Grinder ' Lot Size Water Supply:.Public System and+name ,� - ��'C'---••-• r ••--• --------•-•................:......... .... Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam �... _ Hardpan ❑ -Adobe* Fill Material-_.-.:.....-. If yes,type ...................-------.- (Plot plan, showing size•of lot,.location of system in relation to wells, buildings, etc. must be placed on reverse side.) r NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK t I • (� Size. Liquid Depth ---•----•.._.. ....---.•------------------- .........._. V Capacity Type ---•............... Material ----...._ .- -----_ No. Compartments Distance to nearest: Well . ............ .....................Foundation ...._._. ,._.._......_ Prop. Line ----................:. LEACHING LINE ]t S bio of Lines . .. . ..__ Length of each line. ........ ....:...... ..... Total Length _.------------ 'D' Box ..._. Type Filter Material --------------------Depth Filter. Material ,..------------------.............-.:....- Distance to nearest: Well ------------------------ foundation . ......... ........-L. Property Line ........ SWWVI Depth -.- -... Diameters ./Y. Number .......... ............. Rock Filled Yes [ No Water Table Depth ------ �1 .r__.__._..... Rock Sixe -...07 .. ------------- r Distance to nearest: Well ...... ':. :P ._-Foundations-1.��_--------- Prop. Line Vii................. REPAIR/ADDITION(Prey. Sanitation Permit# ........ ............. - -- Date -:-------- -------- . :.------.:7 ..._Septic Tank (S ecifY.Requirements) ------) .. t Disposal Field (Specify Requirements) ... _--- -------------------------- ------- - ------ ------------_ -- .---.. ........ ---------_---------- . (Draw existing and required addition on reverse side) I hereby certify that i have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Homs owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this .permit is issued, I shall net employ any person in such manner i as to become subject to Workman's Compensation laws of California." B 9 d _:.......... ---------- --- Owner ----- Signed `�'`� - Title . .... 'fes' -!%�" ........ .... By . ..... -� (if other than owner) FOR DEPARTMENT USE ONLY77r- y= k APPLICATION ACCEPTED BY - ---------- ---- --- - . ......---.--....._.._. DATE ........ ._........ ....... � BUILDINGPERMIT ISSUED ._ _.. ....... ........................ ...............11-1............... ... DATE ....... ADDITIONALCOMMENTS ..... .......... ............. --------..-..--------------...-.._... .......-....._.............._.............................._............. ---------------------------- --------- ----------------•-----. ------- ------- - - - •----- ....... - ...........,. ---.........---._..-----• --------------- -------•-------- ------------------- •------------------- --, i Final inspection by: _. ------.:..Date ... 3.--..-... SAN JOAQUIN LOCAL HEALTH DISTRICT Gyy/ _.r u 1.3 24